MHPCA Monthly Quality & Compliance News -December 2016
Jane Moore
MHPCA Quality & Compliance News
Your
Monthly Hospice & Palliative Care Regulatory Resource
Keeping you up-to-date on the ever-changing world of hospice and palliative care. Please share this summary with your staff to ensure they are aware of items pertinent to their areas of responsibility.
NATIONAL NEWS – CMS / MEDICARE / OIG / DEA / ETC.
December 2016
All Providers
OIG Work Plan Published with Many Areas of Focus
Attention: All Providers
On November 10, the Office of Inspector General (OIG) released their FY2017 Work Plan (or see a text based version). The plan addresses Medicare and Medicaid services.
For hospice, the work plan includes several Medicare areas of focus as follows:
• Medicare Hospice Benefit Vulnerabilities and Recommendations for Improvement: A Portfolio – Will summarize OIG evaluations, audits, and investigative work on Medicare hospices and highlight key recommendations to protect beneficiaries and improve the program.
• Review of Hospices’ Compliance with Medicare Requirements – Will review hospice medical records and billing documentation to determine if Medicare payments were made in accordance with requirements.
• Hospice Home Care – Frequency of Nurse On-Site Visits to Assess Quality of Care and Services – Will determine if RNs made required on-site visits every 14 days to supervise hospice aides.
• Medicare Payments for Chronic Care Management – Will determine if payments for CCM services were in accordance with Medicare requirements since CCM cannot be provided during hospice care.
The OIG also noted in a narrative that their plans for this fiscal year and future includes additional oversight of hospice care, including oversight of certification surveys and hospice-worker licensure requirements.
For palliative care, the applicable Medicare areas relate to Evaluation & Management services as follows:
• Physician Home Visits – Reasonableness of Services – Will determine if Medicare payments for Evaluation & Management home visits were reasonable and necessary. The MD must document the medical necessity of a home visit.
• Prolonged Services – Reasonableness of Services – Will determine if Medicare payments to physicians for prolonged E/M services were reasonable and made in accordance with Medicare requirements. They note that the necessity of this level of services is considered to be “rare and unusual” and cite the Medicare Claims Processing Manual, Chapter 12, Section 30.6.15.1 for the requirements that must be met to bill for a prolonged E/M service code.
For home health, two Medicare areas of focus were identified as follows:
• Home Health Services – Comparing HHA Survey Documents to Medicare Claims Data –Will determine whether HHAs are accurately providing patient information to State agencies for recertification surveys.
• Compliance with Medicare Requirements – Will review compliance with various aspects of the home health prospective payment system and include medical review of the documentation required in support of the claims paid by Medicare. Will determine whether home health claims were paid in accordance with Federal requirements.
The OIG cites prior reports as well as other evidence that indicates there may be fraud, waste or abuse taking place. Providers need to review the full report to see the additional OIG provides on each topic.
Earlier Filing of W-2s Required
Attention: Human Resources Staff for All Providers
The IRS has implemented a new federal law that moves up the filing deadline for W-2 forms to January 31. The intent of this change is to help reduce refund fraud. Prior deadlines were the end of February for paper and the end of March if electronic. Ensure that your agency will be prepared to comply with the W-2 filing deadline. View more information in the IRS article.
Home Health & Hospice Providers
Multiple Managers & Staff
Medicare Issues Memo on Part D & Hospice
Attention: All Hospice Staff
MHPCA has addressed through various avenues the concerns of CMS related to medications being billed to Part D that CMS thinks may be the responsibility of hospice. There are also concerns about the lack of coordination between hospices and the Part D plan sponsors. CMS has just published a memo to address this topic in more detail.
The November 15 memo is directed to Part D Plan Sponsors and Medicare Hospice Providers and is titled, “Update on Part D Payment Responsibility for Drugs for Beneficiaries Enrolled in Medicare Hospice.” The memo summarizes data from a recent analysis of Part D claims for hospice beneficiaries and includes as explanation of issues and tables of the expenditures to Part D from 2013-2016.
The data shows that for drugs in the 4 categories – analgesic, anti-nausea, laxative, or anti-anxiety drugs – billing to Part D was 75% less in 2016 than in 2013. Despite this improvement, additional coordination is needed to ensure proper payments for medications.
CMS cites two areas of concern as follows:
• Notification of Hospice Eligibility – CMS reminds hospices that they must respond to requests from Part D plan sponsors (or their contractors) to request repayment for medications that may have been billed inappropriately to Part D. To reduce the risk of these billing issues, hospices are encouraged to submit page 1 of the Information for Medicare Part D Plans form (also known as A3 Reject Form). The memo further explains the notification process and actions that hospice should take to facilitate coordination with the Part D plan sponsor.
• Maintenance Drugs – CMS addressed a concern that the data analysis shows an increase each year in the number of beneficiaries whose maintenance drugs are billed to Part D. Many of these medications are for symptom relief related to the terminal prognosis and are hospice responsibility and should not be billed to Part D. CMS plans to closely monitor these claims because they impact both Medicare’s expenses as well as that of beneficiaries because of their copays.
CMS plans additional data analysis to address what they see as an issue that “affects the quality of care rendered to an especially vulnerable population” and to see why these drugs are not paid for by hospice.
CMS will determine how they can address this type of care coordination in hospice quality measures. They welcome comments and suggestions and those can be submitted to Part...@cms.hhs.gov.
No Grace Period for DEA Renewals
Attention: Physicians, NPs, PAs & Hospice Inpatient Facilities
The Drug Enforcement Administration (DEA) has posted an announcement of an important change to its registration renewal process. Even though not required, previously the DEA has allowed practitioners to have a grace period if they missed the deadline to renew their DEA application.
Effective January 1, 2017, DEA will send only one renewal notification. This notice will go to the registrant’s “mail to” address about 65 days before the expiration date. Failure to file a renewal application by midnight of the expiration date will lead to the DEA number being retired with no option for reinstatement. Once the expiration date passes, the registrant would have to file a new application.
All prescribers as well as hospice inpatient facilities who have DEA registrations need to make note of when their registration expires and track this to ensure renewal in a timely manner. Employers of prescribers also need to pay attention to this as their practitioners will not be able to prescribe controlled substances without an active DEA registration.
Quality Staff
Hospice Quality Reporting Updates
CMS made several announcements related to the Hospice Quality Reporting Program during the November 16 Open Door Forum. Watch the “Spotlight and Announcements” page for more information on these and other topics later this year.
• National HQRP Report – CMS will post a report showing the national averages of HIS and CAHPS scores in December. This will not have provider-level data, but will allow hospices to see how states compare.
• Vendor Authorization – CMS reminds hospices that they must authorize the CAHPS vendor to submit data to the Data Warehouse on its behalf. If not authorized the hospice is at risk of noncompliance with requirements.
• New Hospice Quality Measures Reports – CMS will be added additional reports to CASPER that will show agency-level and patient-level data. These reports should be available in mid-to-late December so monitor the report portal on an ongoing basis.
In addition, CMS has updated the CAHPS Hospice Survey Fact Sheet. They are in the planning stages for Public Reporting and anticipate this will begin summer or fall of 2017. The document has been updated to accompany the recent release of the CAHPS Hospice Survey Quality Assurance Guidelines V3.0.
Hospice Item Set Q&A Document Posted
CMS has posted the Questions and Answers (Q+As) and Quarterly Updates for 3rd quarter 2016. This document addresses frequently asked Hospice Item Set (HIS) related questions that were received by the Quality Help Desk during the third quarter (July-September) of 2016. It also contains quarterly updates and events from the third quarter as well as a coding tip.
Palliative Care Providers
Medicare Publishes 2017 Physician Final Rule
On November 2, CMS finalized the 2017 Physician Fee Schedule final rule that acknowledges the importance of primary care by improving payment for chronic care management and behavioral health. The annual Physician Fee Schedule updates payment policies, payment rates, and quality provisions for services provided in CY 2017. CMS did finalize their proposal to add advance care planning services to the list of approved telehealth services.
The rule also applies to other non-physician practitioners including nurse practitioners and physician assistants. The 2017 payment rule will also enhance program integrity and data transparency in the Medicare Advantage program.
More information is available in the Final Rule and the CMS press release.
Home Health Providers
Change Request Addresses Automated Denial
Attention: HH Billing & Clinical Staff
CMS has published Change Request 9585, Denial of Home Health Payments When Required Patient Assessment Is Not Received, and an accompanying MLN Matters article. These documents address direction to the MACs to automate the denial of HH Prospective Payment System (HH PPS) claims when the condition of payment for submitting patient assessment data has not been met. Make sure that billing staffs are aware of this change.
CMS Publishes Home Health Payment Rule
CMS published the final rule, Medicare Home Health (HH) Prospective Payment System (PPS) for CY 2017. CMS estimates that Medicare payments to home health agencies in CY 2017 would be reduced by 0.7 percent, or $130 million based on the finalized policies.
The final rule addresses the following payment policy provisions: Rebasing the 60-day episode rate, updates to reflect case-mix growth, Negative Pressure Wound Therapy, and a change in methodology and the fixed-dollar loss ratio used to calculate outlier payments. It also addresses updates to the Home Health Quality Reporting Program and the HH Value-Based Purchasing Model.
CMS offers more information in the CMS fact sheet, on the HH PPS website, and on the HH Value-Based Purchasing Model webpage.
Jane Moore
CEO
Missouri Hospice & Palliative Care Assn.
600 Monroe Street
Suite 300
Jefferson City, MO 65101
Phone 573-634-5514
Fax 573-635-0659
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